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Association of DSM-5 Betel-Quid Use Disorder With Oral Potentially Malignant Disorder in 6 Betel-Quid Endemic Asian Populations

Lee CH 1 , Ko AM 2 , Yang FM 3 , Hung CC 4 , Warnakulasuriya S 5 , Ibrahim SO 6 Show all authors , Zain RB 7 , Ko YC 8

Affiliations 

  • 1 Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 2 Key Laboratory of Vertebrate Evolution and Human Origins, Institute of Vertebrate Paleontology and Paleoanthropology, Chinese Academy of Sciences, Beijing, China
  • 3 Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta
  • 4 Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
  • 5 Department of Oral Medicine, King's College London, World Health Organization Collaborating Centre for Oral Cancer and Precancer, London, United Kingdom
  • 6 Department of Biomedicine, University of Bergen, Bergen, Norway
  • 7 Faculty of Dentistry, MAHSA University, Kuala Lumpur, Malaysia
  • 8 Environment-Omics-Disease Research Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
JAMA Psychiatry, 2018 03 01;75(3):261-269.
PMID: 29417149 DOI: 10.1001/jamapsychiatry.2017.4307

Abstract

Importance: Betel-quid (BQ) is the fourth most popular psychoactive agent worldwide. An emerging trend across Asia is the addictive consumption of BQ, which is associated with oral cancer and other health consequences.

Objective: To investigate the validity and pattern of DSM-5-defined BQ use disorder (BUD) and its association with oral potentially malignant disorder (OPMD) among Asian populations.

Design, Setting, and Participants: In-person interviews were conducted from January 1, 2009, to February 28, 2010, among a random sample of 8922 noninstitutionalized adults from the Asian Betel-quid Consortium study, an Asian representative survey of 6 BQ-endemic populations. Statistical analysis was performed from January 1, 2015, to December 31, 2016.

Main Outcomes and Measures: Participants were evaluated for BUD using DSM-5 criteria for substance use disorder and for OPMD using a clinical oral examination. Current users of BQ with 0 to 1 symptoms were classified as having no BUD, those with 2 to 3 symptoms as having mild BUD, those with 4 to 5 symptoms as having moderate BUD, and those with 6 or more symptoms as having severe BUD.

Results: Among the 8922 participants (4564 women and 4358 men; mean [SD] age, 44.2 [0.2] years), DSM-5 symptoms showed sufficient unidimensionality to act as a valid measure for BUD. The 12-month prevalence of DSM-5-defined BUD in the 6 study populations was 18.0% (mild BUD, 3.2%; moderate BUD, 4.3%; and severe BUD, 10.5%). The 12-month proportion of DSM-5-defined BUD among current users of BQ was 86.0% (mild BUD, 15.5%; moderate BUD, 20.6%; and severe BUD, 50.0%). Sex, age, low educational level, smoking, and drinking were significantly associated with BUD. Among individuals who used BQ, family use, high frequency of use, and amount of BQ used were significantly linked to moderate to severe BUD. Compared with individuals who did not use BQ, those who used BQ and had no BUD showed a 22.0-fold (95% CI, 4.3-112.4) risk of OPMD (P 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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